The New HIV and TB Plan Forgets About Sex Workers, Gay Men, Drug-Users And Prisoners

The plan shifts all the responsibility for implementation of the plan to the provinces, who are limited in their resources.

Government's new five-year plan to tackle HIV and TB makes the right noises but is sorely lacking in detail about how it aims to tackle key issues, such as the decriminalisation of sex workers.

The National Strategic Plan (NSP) 2017-2022, was launched the day after the Cabinet reshuffle and got lost in the political noise.

But HIV activist organisations the Treatment Action Campaign (TAC) and Section27 have refused to endorse new NSP, which is usually negotiated in multi-sectoral consultations within the SA National AIDS Council (SANAC) and enjoys broad support.

"While the NSP does contain some language on the decriminalisation of sex work and on the provision of condoms as part of a programme in schools, it fails to plot a concrete way forward," say the TAC and Section27.

Worse, still, they add, it "shifts all the responsibility for implementation of the NSP to provinces" but provides very little guidance to provincial governments on how to develop implementation plans or any mechanisms by which provinces or districts can be held accountable for implementation.

The other two substantial weaknesses also point to vagueness, according to TAC and Section27. The first deals with a lack of proper costing of its plans, or whether funds have been secured to cover these. In addition, many of the proposals will require "substantial increases in human resources", but again it neither quantifies nor costs the staff needed.

The main focus of this NSP is to "intensify efforts" in geographic areas with high HIV and TB rates and "key populations" at a highest risk of getting HIV and TB, including sex workers, men who have sex with men, drug-users and prisoners.

It outlines eight goals with the ultimate target, set by The Joint United Nations Programme on HIV/AIDS (UNAIDS), to "effectively end AIDS as a global public health threat by 2030".

These goals include accelerating HIV prevention, reducing new infections and deaths, addressing the "social drivers" of disease and grounding the fight in human rights principles.

Aside from the vagueness of the plan, activists have called out the leadership of SANAC for its "opaque" consultation processes, claiming that some critical groups and people have been left out.

"There are allegations that the input of critical stakeholders, most especially community groups, have not been taken sufficiently into account," according to Russel Rensburg from the Rural Health Advocacy Project (RHAP).

"It would strengthen the plan's standing if it could make fully transparent the consultation process and how key concerns have been addressed; or if not, why not," wrote Rensburg last week in the TAC/Section27 magazine, Spotlight.

SANAC came under fire earlier this year after its board suddenly decided not to re-appoint its chief executive officer (CEO) Dr Fareed Abdullah weeks before his contract was due to end. Instead of extending his contract, the SANAC board appointed Dr Connie Kganakga as acting CEO.

Abdullah, widely credited for improving SANAC's governance, had been driving the development of the new NSP. A month after Abdullah's departure, a permanent appointment has still not been made although interviews have been conducted.

Earlier this year, TAC claimed that Mmapaseka Steve Letsike, who represents the civil society sector in SANAC, had been using her government contacts to try to secure government tenders for her NGO, Access Chapter Two, as well as for a business she runs with another SANAC representation, Ramneek Ahluwalia.

Despite Leksike and Ahluwalia's denial of being in business together, they are both registered as directors in a company called Media Cliq, and last year pitched a business proposal to the Department of Health, which is now being piloted in KwaZulu-Natal. Ahluwalia represents the higher education sector at SANAC, and is CEO of HEAIDS.

At the time, Lesike's lawyer, Michael Motsoeneng, said there was "nothing preventing our client from 'attempting to solicit' business contracts with any government agency".

But many believe SANAC is not up to the task of co-ordinating the country's HIV response. Said Rensburg: "What is required is a strong SANAC that has the support of all stakeholders. A strong SANAC that can lead, direct and accelerate the response. We fear SANAC in its current state does not meet this muster." – Health-e News.

NSP 2017 – 2022 Goals

Accelerate prevention in order to reduce new HIV and TB infections and new STIs – Breaking the cycle of transmission

Reduce illness and death by providing treatment, care and adherence support for all – 90-90-90 in every district

Reach all key and vulnerable populations with comprehensive, customised and targeted interventions – Nobody left behind

Address social and structural drivers of HIV and TB infection and STIs – a multi-department, multi-sector approach

Ground the response to HIV, TB and STIs in human rights principles and approaches – Equal treatment and social justice

Promote leadership at all levels and shared accountability for a sustainable response to HIV, TB and STIs – Mutual accountability

Mobilise resources to support the achievement of NSP goals and ensure a sustainable response – Spend now, save later